Hand surgery procedures are usually
performed to repair injured hands. These include injuries to
the tendons, nerves, blood vessels, joints, as well as fractured
bones, burns, cuts, and skin wounds. Modern techniques have
greatly improved the surgeon's ability to restore function and
appearance, even in severe injuries.

Among the techniques now used by
hand surgeons are:

Grafting - the
transfer of skin, bone, nerves, or other tissue from a healthy
part of the body to the injured part

Flap
surgery - moving
the skin, along with its underlying fat, blood vessels, and
muscle, from a healthy part of the body to the injured site

Some injuries may require several
operations over an extended period of time.

In many cases, surgery can restore
a significant degree of feeling and function to injured hands,
however, recovery may take months, and a period of hand therapy
will most often be needed.

Carpal Tunnel
Syndrome

The carpal tunnel is a passageway
through the wrist carrying tendons and one of the hand's major
nerves. Pressure may build up within the tunnel because of
disease (such as rheumatoid arthritis), injury, fluid retention
during pregnancy, overuse, or repetitive motions. The
resulting pressure on the nerve within the tunnel causes a
tingling sensation in the hand, often accompanied by numbness,
aching, and impaired hand function. This is known as Carpal
Tunnel Syndrome.

In some cases,
splinting of the hand, cortisone injection and anti-inflammatory
medications will relieve the problem. If this doesn't work,
however, surgery may be required.

During the operation,
the surgeon makes a small incision in the palm near the
wrist. The tissue that's pressing on the nerve will be
loosened, in order to release the pressure. A large dressing
and splint are used, after surgery, to restrict motion and promote
healing. The surgical scar will gradually fade and become
barely visible.

Congenital
Defects

Congenital deformities of the hand - that is, deformities a child
is born with - can interfere with proper hand growth and cause
significant problems in the use of the hand. Fortunately,
with modern surgical techniques, most defects can be corrected at
a very early age - in some cases during infancy, in others, at two
or three years - allowing normal development and functioning of
the hand.

One of the most common congenital
defects is Syndactyly, in which two or more fingers are fused
together. Surgical correction involves cutting the tissue
that connects the fingers, then grafting skin from another part of
the body. (The procedure is more complicated if bones are also
fused.) Surgery can usually provide a full range of motion
and a fairly normal appearance, although the color of the grafted
skin may be slightly different from the rest of the hand.

Other common congenital defects
include short, missing or deformed fingers, immobile tendons, and
abnormal nerves or blood vessels. In most cases, these
defects can be treated surgically and a significant improvement
can be expected.

Dupuytren's
Contracture

Dupuytren's contracture is a disorder of the skin and underlying
tissue on the palm side of the hand. Thick, scar-like tissue
forms under the skin of the palm and may extend into the fingers,
pulling them toward the palm and restricting motion. The
condition usually develops in mid-life and has no known cause
(though it has a tendency to run in families).

Surgery is the only treatment for
Dupuytren's contracture. The surgeon will cut and separate
the bands of thickened tissue, freeing the tendons and allowing
better finger movement. The operation must be done very
precisely, since the nerves that supply the hand and fingers are
often tightly bound up in the abnormal tissue. In some
cases, skin grafts are also needed to replace tightened and
puckered skin.

The results of the surgery will
depend on the severity of the condition. You can usually
expect a thin, fairly inconspicuous scar and significant
improvement in function, particularly after hand therapy.

Trigger
Finger

Trigger finger is a common disorder
of the hand which causes a painful snapping or locking of the
fingers or thumb. The medical name for this condition is
Stenosing Tenosynovitis. Stenosing refers to the narrowing
of an opening or passageway in the body. Tenosynovitis
refers to inflammation of the outer covering of the tendons that
bend and extend the fingers and thumb. The tendons are tough,
fibrous cords that connect the muscles of the forearm to the bones
of the fingers and thumb. This muscle and tendon system
enables one to bend the fingers inward when making a fist, or
extend them straight.

Conservative (non-surgical)
treatment is an appropriate first step, unless the finger or thumb
is in an unmovable, locked position. Initial treatment
involves a cortisone injection as well as avoiding or modifying
those activities that have caused the inflammation.

In cases that do not respond to
conservative treatment, or if the finger or thumb remain in a
locked position, surgery may be recommended.

Surgery is performed on an
out-patient basis under a local anesthetic. A longitudinal
or zigzag incision is made in the palm of the hand at the base of
the affected finger, or a transverse incision for the thumb.
In most cases the surgeon will simply release (cut) the first
annular band, relieving the constriction of the tendon as it
passes through the sheath. The patient may be asked to
actively move the tendon during surgery to confirm whether the
triggering has been relieved.